This Mentored Patient-Oriented Research Career Development Award will provide support for Dr. Compton's development as an independent clinical research scientist. His training goals are as follows: (1) to acquire practical experience in the planning, design, implementation, and evaluation of empirical clinical research with individuals with schizophrenia and their families; (2) to continue training in data analysis, interpretation of results, and dissemination of research findings; (3) to learn the necessary skills for ethically sound, culturally competent research with participants with schizophrenia-spectrum disorders and their families; (4) to gain expertise in prevention-oriented scientific inquiry, especially in the area of secondary prevention-oriented schizophrenia research; and (5) to combine empirical research with a public health perspective, including the translation of findings into clinical practice and appropriate community-level policy changes. Dr. Compton is a psychiatrist and a preventive medicine physician, and his overarching scientific objective is to pursue prevention-oriented schizophrenia research. This K23 application is guided by a secondary prevention paradigm and an ecological conceptual model by studying predictors and outcomes associated with delays in seeking early evaluation and intervention during the initial phases of schizophrenia. Dr. Compton's proposed research will investigate three domains of potential influence on the duration of untreated psychosis (DUP): parent/family factors, patient/illness factors, and services/systems factors. To do so, he will recruit 100 patients with a first-episode of a schizophrenia-spectrum disorder, who will be assessed during their first hospitalization. Dr. Compton will also evaluate cross-sectionally 200 relatives and other informants for his study of factors that may be associated with the length of the DUP. Additionally, he will use a longitudinal research design to sequentially assess the patients for two years from the time of their first hospitalization, to study a variety of outcomes that may be related to the duration and dose of initial psychosis (DDIP), a proposed construct that measures cumulative exposure to initial psychosis (duration until resolution of acute symptoms, and frequency and intensity of symptoms). The overall aim of the research project is to provide an in-depth exploration of the potential causes and consequences of initially untreated psychosis among first-episode patients.